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Repro > Complications in Pregnancy > Flashcards

Complications in Pregnancy Flashcards

1
Q

what is the aetiology of miscarriages?

A

> unknown
abnormal conceptus (structural, genetic, chromosomal)
uterine abnormalities (fibroids, congenital)
maternal (increasing age, diabetes)
cervical incompetence

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2
Q

what is an incomplete miscarriage?

A

most of the pregnancy has been expelled but some of the material is still in the uterus

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3
Q

how does an incomplete miscarriage present?

A

> heavy bleeding

> open cervix

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4
Q

what is a threatened miscarriage?

A

a viable pregnancy but with vaginal bleeding (+/- pain) and a closed cervix

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5
Q

how may an inevitable miscarriage present?

A

> open cervix

> heavy bleeding with clots

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6
Q

what management may an inevitable miscarriage need?

A

evacuation if bleeding heavily

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7
Q

how does a missed miscarriage present?

A

no symptoms or bleeding

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8
Q

how is a missed miscarriage investigated?

A

Ultrasound
> empty gestational sac
> no foetal heart

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9
Q

how is a missed miscarriage managed?

A

> conservative
surgical
medical prostaglandins

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10
Q

what is a miscarriage?

A

termination/loss of pregnancy before 24 weeks gestation

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11
Q

what is a septic miscarriage?

A

infection secondary to miscarriage

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12
Q

how is a septic miscarriage managed?

A

> evacuation

> antibiotics

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13
Q

what is a complete miscarriage?

A

all products of conception passed

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14
Q

how does a complete miscarriage present?

A

> bleeding stopped

> cervix closed

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15
Q

what are some risk factors of ectopic pregnancy?

A

> pelvic inflammatory disease
previous ectopic
previous tubal surgery
assisted conception

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16
Q

what is an ectopic pregnancy?

A

pregnancy implanted outside the uterine cavity

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17
Q

how does an ectopic pregnancy present?

A

> amenorrhea (+ve test)
vaginal bleeding
abdominal pain
GI/urinary symptoms

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18
Q

how is an ectopic pregnancy investigated?

A

> scan (no in-uterine gestational sac, adnexal masses, fluid in pouch of douglas)
serum BHCG levels over 24 hours
serum progesterone levels (25mg/ml is viable pregnancy)

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19
Q

what is the management if ectopic pregnancy?

A

> methotrexate

> surgical salpingectomy or salpingotomy

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20
Q

what is antepartum haemorrhage?

A

haemorrhage from the genital tract after week 24 but before delivery

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21
Q

what local lesions can cause antepartum haemorrhage?

A

> erosions
polyps
cancer

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22
Q

what is vasa praevia?

A

rupture of the foetal vessels causing antepartum haemorrhage

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23
Q

what is placenta praevia?

A

all or some of the placenta implants in the lower part of the uterus

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24
Q

what are some causes of antepartum haemorrhage?

A

> local lesions
vasa praevia
placenta praevia
placental abruption

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25
Q

what are the risk factors for placenta praevia?

A

> multiparous women
multiple pregnancies
previous c-section

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26
Q

what are the classifications of placenta praevia?

A
  1. placenta encroaching on the lower segment. not in int. cervical os
  2. placental reaches internal cervical os
  3. placenta eccentrically covers the os
  4. central placenta praevia
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27
Q

how does placenta praevia present?

A

> PAINLESS PV BLEEDING
malpresentation of the foetus
soft non-tender uterus

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28
Q

how do you diagnose placenta praevia?

A

> ultrasound scan

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29
Q

how is placenta praevia managed?

A 
> C-section
> PPH management  
 - carbaprost
 - ergometrinas
 - tranexamic acid
 - surgical ligation of arteries or hysterectomy
30
Q

what are the risk factors for placental abruption?

A 
> pre-eclampsia
> multiple pregnancy
> parity
> smoking
> polyhydramnios
> previous abruptions
31
Q

what is placental abruption?

A

haemorrhage from premature placenta separation

32
Q

how does placental abruption present?

A

> bleeding
pain
increased uterine activity

33
Q

what are the complications of placental abruption?

A

> PPH
foetal death
maternal shock (DIC/renal failure)

34
Q

what different types of placental abruption?

A

> mixed
concealed: uterus increases in height, blood escaping between placenta and uterine wall
revealed: blood externally escaping

35
Q

what is preterm labour?

A

onset of labour before 37 weeks of completed gestation

36
Q

what are the risk factors for preterm labour?

A 
> multiple pregnancies
> polyhydramnios
> pre-eclampsia
> APH
> infection
> prelabour premature rupture of the membranes
> idiopathic
37
Q

what is extremely preterm labour?

A

24-28 weeks

38
Q

what is very preterm labour?

A

28-32 weeks

39
Q

what is mildly preterm labour?

A

32-36 weeks

40
Q

how do you diagnose preterm labour?

A

> contractions

> evidence of cervical change on VE

41
Q

what is the management of preterm labour?

A

> transfer to unit with NICU
aim for vaginal delivery
consider tocolysis, allow steroid unless contraindicated

42
Q

what is chronic hypertension?

A

hypertension at pre-pregnancy

43
Q

what is mild chronic hypertension?

A

90/140

44
Q

what is chronic moderate hypertension?

A

100/150

45
Q

what is severe chronic hypertension?

A

110/160

46
Q

what is the management for chronic hypertension in pregnancy?

A

> aim for <150/100

> monitor for pre-eclampsia and foetal growth

47
Q

what is pre-eclampsia?

A

mild hypertension on 2 occasions more than 4 hours apart plus proteinuria of >300mgms/ 24 hours

48
Q

what are the risk factors for pre-eclampsia?

A 
> first pregnancy
> multiple pregnancy
> family history
> more than 10 years between pregnancy
> extremes of age
> underlying medical disorders
 - chronic hypertension
 - renal disease
 - diabetes
 - autoimmune disorders
49
Q

what is the pathophysiology in pre-eclampsia?

A

> imbalance in vasodilation and vasoconstriction

> secondary invasion of maternal spinal arteries by trophoblasts impaired so there is decreased placental perfusion

50
Q

what are the investigations for pre-eclampsia?

A 
> BP and urine
> CTG 
> U+E's
> LFT's
> Bloods
51
Q

how does pre-eclampsia present?

A 
> seizures
> reduced urine output
> severe hypertension and urine proteinuria
> vomiting
> swelling of hands, face and legs
> headache
> blurred vision
> epigastric pain
52
Q

what changes in biochem investigations are seen in pre-eclampsia?

A

> increased liver enzymes
bilirubin
increase urate
increased urea

53
Q

what changes in haematological investigations are seen in pre-eclampsia?

A

> decreased platelets
decreased haemoglobin
DIC features

54
Q

what complications of pre-eclampsia are there?

A 
> impaired placental perfusion
> cardiac failure
> pulmonary oedema
> renal failure
> disseminated intravascular coagulopathy
> HELLP
> severe hypertension
> eclampsia
55
Q

what is the conservative management of pre-eclampsia?

A

> steroids
aim for foetal maturity
anti-hypertensives

56
Q

what is the management for pre-eclampsia?

A

induction of labour or c-section

57
Q

what is the management for eclampsia and PET?

A

> seizure control
- avoid fluid overload
- control of BP (IV labetolol)
- magnesium sulphate bolus and IV infusion
prophylaxis in subsequent pregnancies
- low dose aspirin from 12 weeks until delivery

58
Q

how does a venous thrombo-embolism present?

A

> tachycardia
hypoxic
calf pain and swelling
breathlessness, cough, dyspnoea

59
Q

what investigations should be carried out in a venous thrombo-embolism?

A 
> ECG
> blood gases
> doppler
> V/Q scan
> CT pulmonary angiogram
60
Q

what are the risk factors in a venous thrombo-embolism?

A 
> previous VTE
> sickle cell disease
> haemorrhage
> prolonged delivery
> decreased mobility
> dehydration
> infections
> PET
> smoking
> older mothers
> PWID
> increased BMI
61
Q

what prophylaxis is there for a venous thrombo-embolism event?

A

> increasing mobility
TED stockings
hydration
anticoagulation 6 weeks post partum if 3 or more risk factors

62
Q

what causes increased stasis in pregnancy?

A

> progesterone

> enlarging uterus

63
Q

what causes a hypercoagulable state on pregnancy?

A

> increased fibrinolysis
increased fibrinogen
decreased natural anticoagulant (antithrombin 2)

64
Q

what are the risk factors for gestational diabetes?

A 
> BMI >30
> previous macrocosmic baby
> previous GDM
> high diabetic risk
> family history of diabetes
> polyhydramnios current pregnancy
> recurrent glycosuria in pregnancy
65
Q

how screening is there for gestational diabetes?

A

> oral glucose tolerance test at 16 weeks and repeat at 28 weeks if there are significant risk factors
offer HbA1C estimation (if more than 6% off OGTT)

66
Q

what is the management for gestational diabetes?

A

> control of the blood sugar (diet, metformin or insulin)
post delivery: check OGTT at 6-8 weeks
yearly check of HbA1C if at higher risk

67
Q

what hormones significant in pregnancy have anti-insulin actions?

A

> HCG
cortisol
human placental lactogen
progesterone

68
Q

what does foetal hyperinsulinemia lead to?

A

macrosomia

69
Q

what are some complications of pre-existing diabetes in pregnancy?

A 
> foetal congenital abnormalities
> miscarriage
> foetal macrosomia
> shoulder dystocia
> reduced awareness of hypoglycaemia
> pre-eclampsia
> infection
> still birth
> neonatal
 - jaundice
 - impaired lung maturity
 - hypoglycaemia
70
Q

what preconception management is available for diabetes in pregnancy?

A

> glycaemic control (HbA1C <6.5%)
folic acid 5mg
dietary advice
retinal and renal assessment

71
Q

what management is available for diabetes during pregnancy?

A 
> aware of the hypo. risk
> watch for infection
> may need to change to insulin
> labour
 - usually induced at 38-40weeks
 - insulin
 - early feeding of the baby
 - continuous ECG
 - C-section due to macrosomia

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